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Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett's esophagus with early neoplasia: a prospective multicenter study.
Endoscopy. 2013 Jul; 45(7):516-25.E

Abstract

BACKGROUND AND STUDY AIMS

Radiofrequency ablation (RFA) is safe and effective for the eradication of neoplastic Barrett's esophagus; however, occasionally there is minimal regression after initial circumferential balloon-based RFA (c-RFA). This study aimed to identify predictive factors for a poor response 3 months after c-RFA, and to relate the percentage regression at 3 months to the final treatment outcome.

METHODS

We included consecutive patients from 14 centers who underwent c-RFA for high grade dysplasia at worst. Patient and treatment characteristics were registered prospectively. "Poor initial response" was defined as < 50 % regression of the Barrett's esophagus 3 months after c-RFA, graded by two expert endoscopists using endoscopic images. Predictors of initial response were identified through logistic regression analysis.

RESULTS

There were 278 patients included (median Barrett's segment C4M6). In poor initial responders (n = 36; 13 %), complete response for neoplasia (CR-neoplasia) was ultimately achieved in 86 % (vs. 98 % in good responders; P < 0.01) and complete response for intestinal metaplasia (CR-IM) in 66 % (vs. 95 %; P < 0.01). Poor responders required 13 months treatment (vs. 7 months; P < 0.01) for a median of four RFA sessions (vs. three; P < 0.01). We identified four independent baseline predictors of poor response: active reflux esophagitis (odds ratio [OR] 37.4; 95 % confidence interval [CI] 3.2 - 433.2); endoscopic resection scar regeneration with Barrett's epithelium (OR 4.7; 95 %CI 1.1 - 20.0); esophageal narrowing pre-RFA (OR 3.9; 95 %CI 1.0 - 15.1); and years of neoplasia pre-RFA (OR 1.2; 95 %CI 1.0 - 1.4).

CONCLUSIONS

Patients with a poor initial response to c-RFA have a lower ultimate success rate for CR-neoplasia/CR-IM, require more treatment sessions, and a longer treatment period. A poor initial response to c-RFA occurs more frequently in patients who regenerate their endoscopic resection scar with Barrett's epithelium, and those with ongoing reflux esophagitis, neoplasia in Barrett's esophagus for a longer time, or a narrow esophagus.

Authors+Show Affiliations

Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Multicenter Study

Language

eng

PubMed ID

23580412

Citation

van Vilsteren, F G I., et al. "Predictive Factors for Initial Treatment Response After Circumferential Radiofrequency Ablation for Barrett's Esophagus With Early Neoplasia: a Prospective Multicenter Study." Endoscopy, vol. 45, no. 7, 2013, pp. 516-25.
van Vilsteren FG, Alvarez Herrero L, Pouw RE, et al. Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett's esophagus with early neoplasia: a prospective multicenter study. Endoscopy. 2013;45(7):516-25.
van Vilsteren, F. G., Alvarez Herrero, L., Pouw, R. E., Schrijnders, D., Sondermeijer, C. M., Bisschops, R., Esteban, J. M., Meining, A., Neuhaus, H., Parra-Blanco, A., Pech, O., Ragunath, K., Rembacken, B., Schenk, B. E., Visser, M., ten Kate, F. J., Meijer, S. L., Reitsma, J. B., Weusten, B. L., ... Bergman, J. J. (2013). Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett's esophagus with early neoplasia: a prospective multicenter study. Endoscopy, 45(7), 516-25. https://doi.org/10.1055/s-0032-1326423
van Vilsteren FG, et al. Predictive Factors for Initial Treatment Response After Circumferential Radiofrequency Ablation for Barrett's Esophagus With Early Neoplasia: a Prospective Multicenter Study. Endoscopy. 2013;45(7):516-25. PubMed PMID: 23580412.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive factors for initial treatment response after circumferential radiofrequency ablation for Barrett's esophagus with early neoplasia: a prospective multicenter study. AU - van Vilsteren,F G I, AU - Alvarez Herrero,L, AU - Pouw,R E, AU - Schrijnders,D, AU - Sondermeijer,C M T, AU - Bisschops,R, AU - Esteban,J M, AU - Meining,A, AU - Neuhaus,H, AU - Parra-Blanco,A, AU - Pech,O, AU - Ragunath,K, AU - Rembacken,B, AU - Schenk,B E, AU - Visser,M, AU - ten Kate,F J W, AU - Meijer,S L, AU - Reitsma,J B, AU - Weusten,B L A M, AU - Schoon,E J, AU - Bergman,J J G H M, Y1 - 2013/04/11/ PY - 2013/4/13/entrez PY - 2013/4/13/pubmed PY - 2014/2/28/medline SP - 516 EP - 25 JF - Endoscopy JO - Endoscopy VL - 45 IS - 7 N2 - BACKGROUND AND STUDY AIMS: Radiofrequency ablation (RFA) is safe and effective for the eradication of neoplastic Barrett's esophagus; however, occasionally there is minimal regression after initial circumferential balloon-based RFA (c-RFA). This study aimed to identify predictive factors for a poor response 3 months after c-RFA, and to relate the percentage regression at 3 months to the final treatment outcome. METHODS: We included consecutive patients from 14 centers who underwent c-RFA for high grade dysplasia at worst. Patient and treatment characteristics were registered prospectively. "Poor initial response" was defined as < 50 % regression of the Barrett's esophagus 3 months after c-RFA, graded by two expert endoscopists using endoscopic images. Predictors of initial response were identified through logistic regression analysis. RESULTS: There were 278 patients included (median Barrett's segment C4M6). In poor initial responders (n = 36; 13 %), complete response for neoplasia (CR-neoplasia) was ultimately achieved in 86 % (vs. 98 % in good responders; P < 0.01) and complete response for intestinal metaplasia (CR-IM) in 66 % (vs. 95 %; P < 0.01). Poor responders required 13 months treatment (vs. 7 months; P < 0.01) for a median of four RFA sessions (vs. three; P < 0.01). We identified four independent baseline predictors of poor response: active reflux esophagitis (odds ratio [OR] 37.4; 95 % confidence interval [CI] 3.2 - 433.2); endoscopic resection scar regeneration with Barrett's epithelium (OR 4.7; 95 %CI 1.1 - 20.0); esophageal narrowing pre-RFA (OR 3.9; 95 %CI 1.0 - 15.1); and years of neoplasia pre-RFA (OR 1.2; 95 %CI 1.0 - 1.4). CONCLUSIONS: Patients with a poor initial response to c-RFA have a lower ultimate success rate for CR-neoplasia/CR-IM, require more treatment sessions, and a longer treatment period. A poor initial response to c-RFA occurs more frequently in patients who regenerate their endoscopic resection scar with Barrett's epithelium, and those with ongoing reflux esophagitis, neoplasia in Barrett's esophagus for a longer time, or a narrow esophagus. SN - 1438-8812 UR - https://www.unboundmedicine.com/medline/citation/23580412/Predictive_factors_for_initial_treatment_response_after_circumferential_radiofrequency_ablation_for_Barrett's_esophagus_with_early_neoplasia:_a_prospective_multicenter_study_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-0032-1326423 DB - PRIME DP - Unbound Medicine ER -